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Cassa MA, Gentile P, Girón-Hernández J, Ciardelli G, Carmagnola I. Smart self-defensive coatings with bacteria-triggered antimicrobial response for medical devices. Biomater Sci 2024. [PMID: 39320148 DOI: 10.1039/d4bm00936c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Bacterial colonization and biofilm formation on medical devices represent one of the most urgent and critical challenges in modern healthcare. These issues not only pose serious threats to patient health by increasing the risk of infections but also exert a considerable economic burden on national healthcare systems due to prolonged hospital stays and additional treatments. To address this challenge, there is a need for smart, customized biomaterials for medical device fabrication, particularly through the development of surface modification strategies that prevent bacterial adhesion and the growth of mature biofilms. This review explores three bioinspired approaches through which antibacterial and antiadhesive coatings can be engineered to exhibit smart, stimuli-responsive features. This responsiveness is greatly valuable as it provides the coatings with a controlled, on-demand antibacterial response that is activated only in the presence of bacteria, functioning as self-defensive coatings. Such coatings can be designed to release antibacterial agents or change their surface properties/conformation in response to specific stimuli, like changes in pH, temperature, or the presence of bacterial enzymes. This targeted approach minimizes the risk of developing antibiotic resistance and reduces the need for continuous, high-dose antibacterial treatments, thereby preserving the natural microbiome and further reducing healthcare costs. The final part of the review reports a critical analysis highlighting the potential improvements and future evolutions regarding antimicrobial self-defensive coatings and their validation.
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Affiliation(s)
- Maria Antonia Cassa
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Torino 10129, Italy.
- Politecnico di Torino, Polito BIOmed Lab, Torino 10129, Italy
| | - Piergiorgio Gentile
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Joel Girón-Hernández
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Gianluca Ciardelli
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Torino 10129, Italy.
- Politecnico di Torino, Polito BIOmed Lab, Torino 10129, Italy
- National Research Council, Institute for Chemical and Physical Processes (CNR-IPCF), Pisa 56124, Italy
| | - Irene Carmagnola
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Torino 10129, Italy.
- Politecnico di Torino, Polito BIOmed Lab, Torino 10129, Italy
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Zacher AT, Mirza K, Thieme L, Nietzsche S, Senft C, Schwarz F. Biofilm formation of Staphylococcus aureus on various implants used for surgical treatment of destructive spondylodiscitis. Sci Rep 2024; 14:19364. [PMID: 39169088 PMCID: PMC11339328 DOI: 10.1038/s41598-024-70244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 08/14/2024] [Indexed: 08/23/2024] Open
Abstract
The incidence of spondylodiscitis has witnessed a significant increase in recent decades. Surgical intervention becomes necessary in case of bone destruction to remove infected tissue and restore spinal stability, often involving the implantation of a cage. Despite appropriate treatment, relapses occur in up to 20 percent of cases, resulting in substantial economic and social burdens. The formation of biofilm has been identified as a major contributor to relapse development. Currently, there is no consensus among German-speaking spinal surgeons or in the existing literature regarding the preferred choice of material to minimize relapse rates. Thus, the objective of this study is to investigate whether certain materials used in spinal implants exhibit varying degrees of susceptibility to bacterial attachment, thereby providing valuable insights for improving treatment outcomes.Eight cages of each PEEK, titanium-coated PEEK (Ti-PEEK), titanium (Ti), polyetherketoneketone (PEKK), tantalum (Ta) and antibiotic-loaded bone cement were incubated with 20% human plasma for 24 h. Subsequently, four implants were incubated with S. aureus for 24 h or 48 h each. The biofilm was then removed by sonication and the attained solution plated for Colony Forming Units (CFU) counting. Scanning electron microscopy was used to confirm bacterial attachment. The CFUs have been compared directly and in relation to the cages surface area. The surface area of the implants was PEEK 557 mm2, Ti-PEEK 472 mm2, Ti 985 mm2, PEKK 594 mm2, Ta 706 mm2, bone cement 123 mm2. The mean CFU count per implant and per mm2 surface area after 24 h and after 48 h was calculated. Bone cement was found to have significantly more CFUs per mm2 surface area than the other materials tested. When comparing the CFU count per implant, bone cement was statistically significantly more prone to biofilm formation than PEEK after 48 h. There was no statistical significance between the other materials when comparing both CFU count per mm2 surface area and CFU count per implant. The electron microscopic analysis showed the attachment of the bacteria, as well as production of extracellular polymeric substances (EPS) as a sign for beginning biofilm formation. Antibiotic-loaded bone cement has shown statistically significantly more bacterial attachment than the other examined materials. No difference was found between the other materials regarding bacterial attachment after 24 h and 48 h. Proposed hypotheses for further studies include testing whether differences become apparent after longer incubation or with different pathogens involved in the pathogenesis of pyogenic spondylodiscitis.
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Affiliation(s)
- Amrei T Zacher
- Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Kamran Mirza
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University of Jena, Erlanger Allee 103, 07747, Jena, Germany
- Leibnitz Center for Photonics in Infection Research, Jena University Hospital, Friedrich- Schiller-University of Jena, Erlanger Allee 103, 07747, Jena, Germany
| | - Lara Thieme
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University of Jena, Erlanger Allee 103, 07747, Jena, Germany
- Leibnitz Center for Photonics in Infection Research, Jena University Hospital, Friedrich- Schiller-University of Jena, Erlanger Allee 103, 07747, Jena, Germany
| | - Sandor Nietzsche
- Centre for Electron Microscopy, Jena University Hospital, Friedrich-Schiller-University of Jena, Ziegelmühlenweg 1, 07743, Jena, Germany
| | - Christian Senft
- Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Am Klinikum 1, 07747, Jena, Germany
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Delaney LJ, Isguven S, Hilliard R, Lacerda Q, Oeffinger BE, Machado P, Schaer TP, Hickok NJ, Kurtz SM, Forsberg F. In Vitro and In Vivo Evaluation of Ultrasound-Triggered Release From Novel Spinal Device. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2357-2368. [PMID: 37249416 PMCID: PMC10524871 DOI: 10.1002/jum.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/17/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Bacterial infection following spinal fusion is a major clinical concern with up to 20% incidence. An ultrasound-triggered bulk-release system to combat postsurgical bacterial survival was designed and evaluated. METHODS Polylactic acid (PLA) clips were loaded with vancomycin (VAN) and microbubbles (Sonazoid, GE HealthCare) in vitro. Stability was determined over 14 days. VAN-loaded clips were submerged in water and insonated using a Logiq E10 scanner (GE HealthCare) with a curvilinear C6 probe. Doppler-induced VAN release was quantified using spectrophotometry. For in vivo testing, clips were loaded with methylene blue (MeB) solution and Sonazoid. These clips were implanted into a rabbit along the spine at L2 and L5, as well as a pig at L1 and L3, then insonated in Doppler mode using the C6 probe. RESULTS Sonazoid microbubbles were better preserved when incubated in VAN compared with distilled water at 4°C, 25°C, and 37°C incubation temperatures (P = .0131). Contrast enhancement was observed from both solutions when incubated at 4°C storage conditions. Insonated clips achieved average cumulative VAN release of 101.8 ± 2.8% (81.4 ± 2.8 mg) after 72 hours. Uninsonated clips had only 0.3 ± 0.1% (0.3 ± 0.1 mg) average cumulative VAN release (P < .0001). Clips retrieved from the rabbit did not rupture with insonation nor produce MeB staining of surrounding tissues. In the pig, the PLA film was visibly ruptured and MeB tissue was observed following insonation, whereas the uninsonated clip was intact. CONCLUSION These results demonstrate ultrasound-triggered release of an encapsulated prophylactic solution and provide an important proof-of-concept for continuing large animal evaluations for translational merit.
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Affiliation(s)
- Lauren J. Delaney
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19107
| | - Selin Isguven
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19107
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, 19107
| | - Rachel Hilliard
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, 19348
| | - Quezia Lacerda
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19107
- School of Biomedical Engineering, Science & Health Systems, Drexel University, Philadelphia, PA, 19104
| | - Brian E. Oeffinger
- School of Biomedical Engineering, Science & Health Systems, Drexel University, Philadelphia, PA, 19104
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19107
| | - Thomas P. Schaer
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, 19348
| | - Noreen J. Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, 19107
| | - Steven M. Kurtz
- School of Biomedical Engineering, Science & Health Systems, Drexel University, Philadelphia, PA, 19104
- Exponent, Inc., Philadelphia, PA, 19104
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19107
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Liu C, Huang Z, Zhu J, Liu X, Zhu B, Zheng D, Yang B, Tao R, Cai C, Chen X, Liu J, Deng Z. Near-ultraviolet irradiation to stimulate unmodified polyether ether ketone to achieve stable and sustainable antibacterial activity. Colloids Surf B Biointerfaces 2023; 229:113441. [PMID: 37422990 DOI: 10.1016/j.colsurfb.2023.113441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES This study aims to investigate the cytotoxicity and sustainable antibacterial activity of unmodified PEEK under specific wavelength light treatment (365 nm), and its antibacterial mechanism was also preliminarily discussed. METHODS A near-ultraviolet source with a wavelength of 365 nm and a power of 5 W were selected. The irradiation time was 30 min, and the distance was 100 mm. A water contact angle tester was used to characterize the surface of the PEEK after 1-15 light treatments. MC3TC-E1 cells were used to evaluate the cytotoxicity of the materials under light treatment. Five kinds of common oral bacteria were detected in vitro, and antibacterial efficiency was determined by colony-forming unit (CFU) and scanning electron microscope (SEM). The antibacterial mechanism of PEEK under light was preliminarily discussed by spectrophotometry. The membrane rupture of Staphylococcus aureus and Escherichia coli was detected by lactate dehydrogenase. Staphylococcus aureus and Staphylococcus mutans were selected for the cyclic antibacterial test. Statistical analysis was performed by one-way analysis of variance and Tukey multiple range test. A significance level of 0.05 was considered (α = 0.05). RESULTS The results of the cell experiment showed that PEEK had no cytotoxicity (P > 0.05). CFU results showed that PEEK had an obvious antibacterial effect on Staphylococcus aureus, Staphylococcus mutans, Staphylococcus gordonii and Staphylococcus sanguis, but had no antibacterial effect on Escherichia coli (P < 0.05). The SEM results also verified the above antibacterial effect. The existence of singlet oxygen was confirmed by spectrophotometry. Meanwhile, the rupture of Staphylococcus aureus membrane was verified by lactate dehydrogenase assay. The water contact angle of the PEEK surface did not change significantly after 15 cycles of light treatment. Cyclic antibacterial experiments showed that the antibacterial effect was sustainable. CONCLUSIONS This study showed that PEEK has good cytocompatibility with stable and sustainable antibacterial properties under near-ultraviolet. It provides a new idea to solve the non-antibacterial property of PEEK, and also provides a theoretical basis for its further application in dentistry.
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Affiliation(s)
- Chongxing Liu
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhuo Huang
- Department of Stomatology, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing TCM Hospital Affiliated to Zhejiang Chinese Medical University, Shaoxing 312000, China
| | - Jinlei Zhu
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Xiangzhi Liu
- Clinical medical college of Tianjin medical university, Tianjin 300010, China
| | - Bingbing Zhu
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Dongyang Zheng
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Bingqian Yang
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Ran Tao
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Chenxi Cai
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Xiao Chen
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China
| | - Jinsong Liu
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China.
| | - Zhennan Deng
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325000, China.
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Zhang Z, Shao J, Gao Y, Li Y, Liu T, Yang M. Research progress and future prospects of antimicrobial modified polyetheretherketone (PEEK) for the treatment of bone infections. Front Bioeng Biotechnol 2023; 11:1244184. [PMID: 37600311 PMCID: PMC10436002 DOI: 10.3389/fbioe.2023.1244184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Infection of the bone is a difficult problem in orthopedic diseases. The key and basis of the treatment of bone infection is the effective control of local infection, as well as the elimination of infection focus and dead cavities. The most commonly used approach utilized for the prevention and management of bone infection is the application of antibiotic bone cement. However, the incorporation of antibiotics into the cement matrix has been found to considerably compromise the mechanical characteristics of bone cement. Moreover, some investigations have indicated that the antibiotic release rate of antibiotic bone cement is relatively low. Polyetheretherketone (PEEK) and its composites have been considered to perfectly address the challenges above, according to its favorable biomechanical characteristics and diverse surface functionalizations. This article provides a comprehensive overview of the recent advancements in the antimicrobial modification of PEEK composites in the field of antibacterial therapy of bone infection. Furthermore, the potential application of PEEK-modified materials in clinical treatment was discussed and predicted.
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Affiliation(s)
- Ziyi Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Junxing Shao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yu Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yuhuan Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Te Liu
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Modi Yang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Smith JA, Petersmann S, Arbeiter F, Schäfer U. Optimization and manufacture of polyetheretherketone patient specific cranial implants by material extrusion - A clinical perspective. J Mech Behav Biomed Mater 2023; 144:105965. [PMID: 37343357 DOI: 10.1016/j.jmbbm.2023.105965] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
Polyetheretherketone (PEEK) is a high performing thermoplastic that has established itself as a 'gold-standard' material for cranial reconstruction. Traditionally, milled PEEK patient specific cranial implants (PSCIs) exhibit uniform levels of smoothness (excusing suture/drainage holes) to the touch (<1 μm) and homogenous coloration throughout. They also demonstrate predictable and repeatable levels of mechanical performance, as they are machined from isotropic material blocks. The combination of such factors inspires confidence from the surgeon and in turn, approval for implantation. However, manufacturing lead-times and affiliated costs to fabricate a PSCI are high. To simplify their production and reduce expenditure, hospitals are exploring the production of in-house PEEK PSCIs by material extrusion-based additive manufacturing. From a geometrical and morphological perspective, such implants have been produced with good-to-satisfactory clinical results. However, lack of clinical adoption persists. To determine the reasoning behind this, it was necessary to assess the benefits and limitations of current printed PEEK PSCIs in order to establish the status quo. Afterwards, a review on individual PEEK printing variables was performed in order to identify a combination of parameters that could enhance the aesthetics and performance of the PSCIs to that of milled implants/cranial bone. The findings from this review could be used as a baseline to help standardize the production of PEEK PSCIs by material extrusion in the hospital.
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Affiliation(s)
- James A Smith
- Research Unit Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 2(9), 8036, Graz, Austria.
| | - Sandra Petersmann
- Materials Science and Testing of Polymers, Montanuniversitaet Leoben, Otto Gloeckel-Straße 2, 8700, Leoben, Austria
| | - Florian Arbeiter
- Materials Science and Testing of Polymers, Montanuniversitaet Leoben, Otto Gloeckel-Straße 2, 8700, Leoben, Austria
| | - Ute Schäfer
- Research Unit Experimental Neurotraumatology, Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 2(9), 8036, Graz, Austria; BioTechMed-Graz, Graz, Austria
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Talebian S, Mendes B, Conniot J, Farajikhah S, Dehghani F, Li Z, Bitoque D, Silva G, Naficy S, Conde J, Wallace GG. Biopolymeric Coatings for Local Release of Therapeutics from Biomedical Implants. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2207603. [PMID: 36782094 PMCID: PMC10131825 DOI: 10.1002/advs.202207603] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Indexed: 06/18/2023]
Abstract
The deployment of structures that enable localized release of bioactive molecules can result in more efficacious treatment of disease and better integration of implantable bionic devices. The strategic design of a biopolymeric coating can be used to engineer the optimal release profile depending on the task at hand. As illustrative examples, here advances in delivery of drugs from bone, brain, ocular, and cardiovascular implants are reviewed. These areas are focused to highlight that both hard and soft tissue implants can benefit from controlled localized delivery. The composition of biopolymers used to achieve appropriate delivery to the selected tissue types, and their corresponding outcomes are brought to the fore. To conclude, key factors in designing drug-loaded biopolymeric coatings for biomedical implants are highlighted.
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Affiliation(s)
- Sepehr Talebian
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyNSW2006Australia
- Nano Institute (Sydney Nano)The University of SydneySydneyNSW2006Australia
| | - Bárbara Mendes
- ToxOmicsNOVA Medical School|Faculdade de Ciências MédicasNMS|FCMUniversidade Nova de LisboaLisboa1169‐056Portugal
| | - João Conniot
- ToxOmicsNOVA Medical School|Faculdade de Ciências MédicasNMS|FCMUniversidade Nova de LisboaLisboa1169‐056Portugal
| | - Syamak Farajikhah
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyNSW2006Australia
- Nano Institute (Sydney Nano)The University of SydneySydneyNSW2006Australia
| | - Fariba Dehghani
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyNSW2006Australia
- Nano Institute (Sydney Nano)The University of SydneySydneyNSW2006Australia
| | - Zhongyan Li
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyNSW2006Australia
| | - Diogo Bitoque
- ToxOmicsNOVA Medical School|Faculdade de Ciências MédicasNMS|FCMUniversidade Nova de LisboaLisboa1169‐056Portugal
| | - Gabriela Silva
- ToxOmicsNOVA Medical School|Faculdade de Ciências MédicasNMS|FCMUniversidade Nova de LisboaLisboa1169‐056Portugal
| | - Sina Naficy
- School of Chemical and Biomolecular EngineeringThe University of SydneySydneyNSW2006Australia
- Nano Institute (Sydney Nano)The University of SydneySydneyNSW2006Australia
| | - João Conde
- ToxOmicsNOVA Medical School|Faculdade de Ciências MédicasNMS|FCMUniversidade Nova de LisboaLisboa1169‐056Portugal
| | - Gordon G. Wallace
- Intelligent Polymer Research InstituteARC Centre of Excellence for Electromaterials ScienceAIIM FacilityUniversity of WollongongSydneyNSW2522Australia
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Resina L, El Hauadi K, Sans J, Esteves T, Ferreira FC, Pérez-Madrigal MM, Alemán C. Electroresponsive and pH-Sensitive Hydrogel as Carrier for Controlled Chloramphenicol Release. Biomacromolecules 2023; 24:1432-1444. [PMID: 36821593 PMCID: PMC10889591 DOI: 10.1021/acs.biomac.2c01442] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Multiresponsive hydrogels, which are smart soft materials that respond to more than one external stimulus, have emerged as powerful tools for biomedical applications, such as drug delivery. Within this context and with the aim of eliminating the systematic administration of antibiotics, special attention is being paid to the development of systems for controlled delivery of antibiotic for topical treatment of bacterial infections. In this work, an electro-chemo responsive hydrogel able to release chloramphenicol (CAM), a broad spectrum antibiotic also used for anticancer therapy, is proposed. This has been prepared by grafting poly(acrylic acid) (PAA) to sodium alginate (Alg) and in situ encapsulation of poly(3,4-ethylenedioxythiophene) nanoparticles loaded with CAM (PEDOT/CAM NPs), which were obtained by emulsion polymerization. Although the response to electrical stimuli of PEDOT was the main control for the release of CAM from PEDOT/CAM NPs, the release by passive diffusion had a relatively important contribution. Conversely, the passive release of antibiotic from the whole engineered hydrogel system, Alg-g-PAA/PEDOT/CAM, was negligible, whereas significant release was achieved under electrostimulation in an acid environment. Bacterial tests and assays with cancer cells demonstrated that the biological activity of CAM remained after release by electrical stimulation. Notably, the successful dual-response of the developed hydrogel to electrical stimuli and pH changes evidence the great prospect of this smart material in the biomedical field, as a tool to fight against bacterial infections and to provide local cancer treatment.
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Affiliation(s)
- Leonor Resina
- Departament d'Enginyeria Química and Barcelona Research Center for Multiscale Science and Engineering, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany 10-14, 08019 Barcelona, Spain
- iBB - Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico - Universidade de Lisboa, Avenida Rovisco Pais 1, 1049-001 Lisboa, Portugal
- Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Karima El Hauadi
- Departament d'Enginyeria Química and Barcelona Research Center for Multiscale Science and Engineering, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Jordi Sans
- Departament d'Enginyeria Química and Barcelona Research Center for Multiscale Science and Engineering, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Teresa Esteves
- iBB - Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico - Universidade de Lisboa, Avenida Rovisco Pais 1, 1049-001 Lisboa, Portugal
- Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Frederico Castelo Ferreira
- iBB - Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico - Universidade de Lisboa, Avenida Rovisco Pais 1, 1049-001 Lisboa, Portugal
- Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Maria M Pérez-Madrigal
- Departament d'Enginyeria Química and Barcelona Research Center for Multiscale Science and Engineering, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany 10-14, 08019 Barcelona, Spain
| | - Carlos Alemán
- Departament d'Enginyeria Química and Barcelona Research Center for Multiscale Science and Engineering, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany 10-14, 08019 Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028 Barcelona, Spain
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9
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Su Z, Zhang J, Tan P, Zhu S, Jiang N. Selective Polyetheretherketone Implants Combined with Graphene Cause Definitive Cell Adhesion and Osteogenic Differentiation. Int J Nanomedicine 2022; 17:5327-5338. [PMID: 36411765 PMCID: PMC9675333 DOI: 10.2147/ijn.s380345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/30/2022] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION Polyetheretherketone (PEEK) has good biosafety and chemical stability for bone repair. However, PEEK is biologically inert and cannot promote bone apposition. This study investigated whether graphene-modified PEEK (G-PEEK) could improve cell adhesion and osteogenic differentiation. METHODS G-PEEK was prepared by melted blending and was characterized. In vitro, the biocompatibility of G-PPEK and the ability to promote cell adhesion and osteogenic differentiation in rabbit bone marrow mesenchymal stem cells (rBMSCs) were examined using live and dead cell double staining, the cell counting kit-8 (CCK-8) assay, immunofluorescence and quantitative real-time PCR (qRT‒PCR). An in vivo rabbit extra-articular graft-to-bone healing model was established. At 4 and 12 weeks after surgery, CT analysis and histological evaluation were performed. RESULTS In vitro, G-PEEK significantly improved the adhesion and proliferation of rBMSCs, with good biocompatibility. In vivo, G-PEEK promoted new bone formation at the site of the bone defect. CONCLUSION G-PEEK showed excellent osteogenesis performance, which promises new applications in implant materials.
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Affiliation(s)
- Zhan Su
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jie Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Peijie Tan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Songsong Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, People’s Republic of China
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10
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Basgul C, Thieringer FM, Kurtz SM. Heat Transfer-Based Non-isothermal Healing Model for the Interfacial Bonding Strength of Fused Filament Fabricated Polyetheretherketone. ADDITIVE MANUFACTURING 2022; 46:102097. [PMID: 35155134 PMCID: PMC8827803 DOI: 10.1016/j.addma.2021.102097] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Fused Filament Fabrication (FFF) as an Additive Manufacturing (AM) method for Polyetheretherketone (PEEK) has established a promising future for medical applications so far, however interlayer delamination as a failure mechanism for FFF implants has raised critical concerns. A one-dimensional (1D) heat transfer model (HTM) was developed to compute the layer and interlayer temperatures by considering the nature of 3D printing for FFF PEEK builds. The HTM was then coupled with a non-isothermal healing model to predict the interlayer strength through thickness of a FFF PEEK part. We then conducted a parametric study of the primary temperature effects of the FFF system, including the print bed, nozzle, and chamber temperatures, on layer healing. The heat transfer component of the model for the FFF PEEK layer healing assessment was validated separately. An idealized PEEK cube design (10x10x10 mm3) was used for model development and 3D printed in commercially available industrial and medical FFF machines. During the printing and cooling processes of FFF, thermal videos were recorded in both printers using a calibrated infrared camera. Thermal images were then processed to obtain time-dependent layer temperature profiles of FFF PEEK prints. Both the theoretical model and experiments confirmed that the upper layers in reference to the print bed exhibited higher temperatures, thus higher healing degrees than the lower layers. Increasing the print bed temperature increased the healing of the layers allowing more layers to heal 100%. The nozzle temperature showed the most significant effect on the layer healing, and under certain nozzle temperature, none of the layers healed adequately. Although environment temperature had less impact on the lower layers closer to the print bed, 100% healed layer number increased when the chamber temperature increased. The model predictions were in good agreement with the experimental data, particularly for the mid-part of FFF PEEK cubes printed in both FFF machines.
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Affiliation(s)
- Cemile Basgul
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA
| | - Florian M. Thieringer
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Steven M. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA
- Exponent, Inc., Philadelphia, PA
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Su Y, Yrastorza JT, Matis M, Cusick J, Zhao S, Wang G, Xie J. Biofilms: Formation, Research Models, Potential Targets, and Methods for Prevention and Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2203291. [PMID: 36031384 PMCID: PMC9561771 DOI: 10.1002/advs.202203291] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/31/2022] [Indexed: 05/28/2023]
Abstract
Due to the continuous rise in biofilm-related infections, biofilms seriously threaten human health. The formation of biofilms makes conventional antibiotics ineffective and dampens immune clearance. Therefore, it is important to understand the mechanisms of biofilm formation and develop novel strategies to treat biofilms more effectively. This review article begins with an introduction to biofilm formation in various clinical scenarios and their corresponding therapy. Established biofilm models used in research are then summarized. The potential targets which may assist in the development of new strategies for combating biofilms are further discussed. The novel technologies developed recently for the prevention and treatment of biofilms including antimicrobial surface coatings, physical removal of biofilms, development of new antimicrobial molecules, and delivery of antimicrobial agents are subsequently presented. Finally, directions for future studies are pointed out.
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Affiliation(s)
- Yajuan Su
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jaime T. Yrastorza
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Mitchell Matis
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jenna Cusick
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Siwei Zhao
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Guangshun Wang
- Department of Pathology and MicrobiologyCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jingwei Xie
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
- Department of Mechanical and Materials EngineeringCollege of EngineeringUniversity of Nebraska‐LincolnLincolnNE68588USA
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12
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Zhang S, Long J, Chen L, Zhang J, Fan Y, Shi J, Huang Y. Treatment methods toward improving the anti-infection ability of poly(etheretherketone) implants for medical applications. Colloids Surf B Biointerfaces 2022; 218:112769. [PMID: 35994991 DOI: 10.1016/j.colsurfb.2022.112769] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
Due to its favorable chemical stability, biocompatibility, and mechanical properties, Poly(etheretherketone) (PEEK) is a promising material for repairing bone and dental hard tissue defects. However, there are critical disadvantages: PEEK is biologically and chemically inert, which influences osseointegration of implants and bonding strength of prostheses, and its mechanical properties still cannot meet the requirements for some medical applications. Furthermore, bacterial infections and inflammatory reactions often accompany bone defects caused by trauma or inflammation or teeth loss caused by periodontitis. Previous studies mainly focused on enhancing PEEK's bioactivity and mechanical performance, but PEEK also lacks effective anti-infection ability. Thus, it is necessary to improve its anti-infection ability, and this is considered in this paper from two aspects. The first is to inhibit the attachment and growth of bacteria on the material, and the second is to endow the material with immunoregulatory ability, which means mobilizing the host immune system to protect tissue from inflammation. In this review, we analyze and discuss the existing treatment methods to improve the antibacterial and immunomodulatory abilities of PEEK addressing their limitations, relevant future challenges, and required research efforts.
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Affiliation(s)
- Shuqi Zhang
- Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulvard, Guangzhou 510280, China.
| | - Jiazhen Long
- Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulvard, Guangzhou 510280, China.
| | - Lin Chen
- Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulvard, Guangzhou 510280, China.
| | - Jie Zhang
- Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulvard, Guangzhou 510280, China.
| | - Yunjian Fan
- Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulvard, Guangzhou 510280, China.
| | - Jiayu Shi
- Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulvard, Guangzhou 510280, China.
| | - Yuanjin Huang
- Stomatological Hospital, Southern Medical University, S366 Jiangnan Boulvard, Guangzhou 510280, China.
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13
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Application of biomolecules modification strategies on PEEK and its composites for osteogenesis and antibacterial properties. Colloids Surf B Biointerfaces 2022; 215:112492. [PMID: 35430485 DOI: 10.1016/j.colsurfb.2022.112492] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/24/2022] [Accepted: 04/04/2022] [Indexed: 12/24/2022]
Abstract
As orthopedic and dental implants, polyetheretherketone (PEEK) is expected to be a common substitute material of titanium (Ti) and its alloys due to its good biocompatibility, chemical stability, and elastic modulus close to that of bone tissue. It could avoid metal allergy and bone resorption caused by the stress shielding effect of Ti implants, widely studied in the medical field. However, the lack of biological activity is not conducive to the clinical application of PEEK implants. Therefore, the surface modification of PEEK has increasingly become one of the research hotspots. Researchers have explored various biomolecules modification methods to effectively enhance the osteogenic and antibacterial activities of PEEK and its composites. Therefore, this review mainly summarizes the recent research of PEEK modified by biomolecules and discusses the further research directions to promote the clinical transformation of PEEK implants.
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Delaney LJ, Isguven S, Eisenbrey JR, Hickok NJ, Forsberg F. Making waves: how ultrasound-targeted drug delivery is changing pharmaceutical approaches. MATERIALS ADVANCES 2022; 3:3023-3040. [PMID: 35445198 PMCID: PMC8978185 DOI: 10.1039/d1ma01197a] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 05/06/2023]
Abstract
Administration of drugs through oral and intravenous routes is a mainstay of modern medicine, but this approach suffers from limitations associated with off-target side effects and narrow therapeutic windows. It is often apparent that a controlled delivery of drugs, either localized to a specific site or during a specific time, can increase efficacy and bypass problems with systemic toxicity and insufficient local availability. To overcome some of these issues, local delivery systems have been devised, but most are still restricted in terms of elution kinetics, duration, and temporal control. Ultrasound-targeted drug delivery offers a powerful approach to increase delivery, therapeutic efficacy, and temporal release of drugs ranging from chemotherapeutics to antibiotics. The use of ultrasound can focus on increasing tissue sensitivity to the drug or actually be a critical component of the drug delivery. The high spatial and temporal resolution of ultrasound enables precise location, targeting, and timing of drug delivery and tissue sensitization. Thus, this noninvasive, non-ionizing, and relatively inexpensive modality makes the implementation of ultrasound-mediated drug delivery a powerful method that can be readily translated into the clinical arena. This review covers key concepts and areas applied in the design of different ultrasound-mediated drug delivery systems across a variety of clinical applications.
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Affiliation(s)
- Lauren J Delaney
- Department of Radiology, Thomas Jefferson University 132 S. 10th Street, Main 763 Philadelphia PA 19107 USA +1 (215) 955-4870
| | - Selin Isguven
- Department of Radiology, Thomas Jefferson University 132 S. 10th Street, Main 763 Philadelphia PA 19107 USA +1 (215) 955-4870
- Department of Orthopaedic Surgery, Thomas Jefferson University, 1015 Walnut Street Philadelphia PA 19107 USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University 132 S. 10th Street, Main 763 Philadelphia PA 19107 USA +1 (215) 955-4870
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University, 1015 Walnut Street Philadelphia PA 19107 USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University 132 S. 10th Street, Main 763 Philadelphia PA 19107 USA +1 (215) 955-4870
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Webster TJ, Shallenberger JR, Edelman ER, Khoury J. Accelerated Neutral Atom Beam (ANAB) Modified Poly-Ether-Ether-Ketone for Increasing In Vitro Bone Cell Functions and Reducing Bacteria Colonization Without Drugs or Antibiotics. J Biomed Nanotechnol 2022; 18:788-795. [PMID: 35715916 DOI: 10.1166/jbn.2022.3247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Poly-ether-ether-ketone (PEEK) has become the spinal implant material of choice due to its radiolucency, low elastic modulus, manufacturability, and mechanical durability. However, studies have highlighted less that optimal cytocompatibility properties of conventional PEEK leading to decreased bone growth and/or extensive bacteria infection. In order to improve the surface properties of PEEK for orthopedic applications, here, Accelerated Neutral Atom Beam (ANAB) technology was used to modify PEEK and such samples were tested In Vitro for osteoblast (bone-forming cell) functions and bacterial colonization. Results showed significantly improved osteoblast responses (such as deposition of calcium containing mineral as well as alkaline phosphatase, osteocalcin, osteopontin, and osteonectin synthesis) on ANAB modified PEEK compared to controls due to optimized surface energy from nanostructured features and greater exposure of PEEK chemistry. ANAB treatment enhanced protein absorption (specifically, mucin, casein, and lubricin) to the PEEK surface and consequently significantly reduced bacterial (including methicillin resistant Staph. aureus (or MRSA), E. coli, and Staph. epidermidis) colonization. Collectively, this study introduces ANAB treated PEEK as a novel material that should be further studied for a wide range of improved orthopedic applications.
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Affiliation(s)
- Thomas J Webster
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA
| | - Jeffrey R Shallenberger
- Materials Characterization Laboratory, Pennsylvania State University, University Park, PA 16802, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge MA 02139 and Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston MA 02115, USA
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16
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Stimuli-sensitive drug delivery systems for site-specific antibiotic release. Drug Discov Today 2022; 27:1698-1705. [DOI: 10.1016/j.drudis.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/19/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
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17
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Hu CC, Kumar SR, Vi TTT, Huang YT, Chen DW, Lue SJ. Facilitating GL13K Peptide Grafting on Polyetheretherketone via 1-Ethyl-3-(3-dimethylaminopropyl)carbodiimide: Surface Properties and Antibacterial Activity. Int J Mol Sci 2021; 23:ijms23010359. [PMID: 35008782 PMCID: PMC8745129 DOI: 10.3390/ijms23010359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
In the present work, the antimicrobial peptide (AMP) of GL13K was successfully coated onto a polyetheretherketone (PEEK) substrate to investigate its antibacterial activities against Staphylococcus aureus (S. aureus) bacteria. To improve the coating efficiency, 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) was mixed with a GL13K solution and coated on the PEEK surface for comparison. Both energy-dispersive X-ray spectroscopy (EDX) and X-ray photoelectron spectroscopy (XPS) data confirmed 30% greater peptide coating on PEEK/GL13K-EDC than PEEK without EDC treatment. The GL13K graft levels are depicted in the micrograms per square centimeter range. The PEEK/GL13K-EDC sample showed a smoother and lower roughness (Rq of 0.530 µm) than the PEEK/GL13K (0.634 µm) and PEEK (0.697 µm) samples. The surface of the PEEK/GL13K-EDC was more hydrophilic (with a water contact angle of 24°) than the PEEK/GL13K (40°) and pure PEEK (89°) samples. The pure PEEK disc did not exhibit any inhibition zone against S. aureus. After peptide coating, the samples demonstrated significant zones of inhibition: 28 mm and 25 mm for the PEEK/GL13K-EDC and PEEK/GL13K samples, respectively. The bacteria-challenged PEEK sample showed numerous bacteria clusters, whereas PEEK/GL13K contained a little bacteria and PEEK/GL13K-EDC had no bacterial attachment. The results confirm that the GL13K peptide coating was able to induce antibacterial and biofilm-inhibitory effects. To the best of our knowledge, this is the first report of successful GL13K peptide grafting on a PEEK substrate via EDC coupling. The present work illustrates a facile and promising coating technique for a polymeric surface to provide bactericidal activity and biofilm resistance to medical implantable devices.
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Affiliation(s)
- Chih-Chien Hu
- Division of Join Reconstruction, Department of Orthopedics, Chang Gung Medical Center at Linkou, Guishan District, Taoyuan City 333, Taiwan;
| | - Selvaraj Rajesh Kumar
- Department of Chemical and Materials Engineering, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
| | - Truong Thi Tuong Vi
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Chang Gung Memorial Hospital, Guishan District, Taoyuan City 333, Taiwan;
| | - Yu-Tzu Huang
- Department of Chemical Engineering, Chung Yuan Christian University, Zhongli, Taoyuan City 320, Taiwan;
- R&D Center for Membrane Technology and Research Center for Circular Economy, Chung Yuan Christian University, Zhongli, Taoyuan City 320, Taiwan
| | - Dave W. Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung City 204, Taiwan;
| | - Shingjiang Jessie Lue
- Division of Join Reconstruction, Department of Orthopedics, Chang Gung Medical Center at Linkou, Guishan District, Taoyuan City 333, Taiwan;
- Department of Chemical and Materials Engineering, Chang Gung University, Guishan District, Taoyuan City 333, Taiwan;
- Department of Safety, Health and Environment Engineering, Ming Chi University of Technology, Taishan District, New Taipei City 243, Taiwan
- Correspondence: ; Tel.: +88-63-2118800 (ext. 5489); Fax: +88-63-2118700
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18
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He M, Huang Y, Xu H, Feng G, Liu L, Li Y, Sun D, Zhang L. Modification of polyetheretherketone implants: From enhancing bone integration to enabling multi-modal therapeutics. Acta Biomater 2021; 129:18-32. [PMID: 34020056 DOI: 10.1016/j.actbio.2021.05.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/02/2021] [Accepted: 05/07/2021] [Indexed: 02/08/2023]
Abstract
Polyetheretherketone (PEEK) is a popular thermoplastic material widely used in engineering applications due to its favorable mechanical properties and stability at high temperatures. With the first implantable grade PEEK being commercialized in 1990s, the use of PEEK has since grown exponentially in the biomedical field and has rapidly transformed a large section of the medical devices landscape. Nowadays, PEEK is a standard biomaterial used across a wide range of implant applications, however, its bioinertness remains a limitation for bone repair applications. The increasing demand for enhanced treatment efficacy/improved patient quality of life, calls for next-generation implants that can offer fast bone integration as well as other desirable therapeutic functions. As such, modification of PEEK implants has progressively shifted from offering desirable mechanical properties, enhancing bioactivity/fast osteointegration, to more recently, tackling post-surgery bacterial infection/biofilm formation, modulation of inflammation and management of bone cancers. Such progress is also accompanied by the evolution of the PEEK manufacturing technologies, to meet the ever increasing demand for more patient specific devices. However, no review has comprehensively covered the recently engaged application areas to date. This paper provides an up-to-date review on the development of PEEK-based biomedical devices in the past 10 years, with particularly focus on modifying PEEK for multi-modal therapeutics. The aim is to provide the peers with a timely update, which may guide and inspire the research and development of next generation PEEK-based healthcare products. STATEMENT OF SIGNIFICANCE: Significant progress has been made in PEEK processing and modification techniques in the past decades, which greatly contributed to its wide applications in the biomedical field. Despite the high volume of published literature on PEEK implant related research, there is a lack of review on its emerging applications in multi-modal therapeutics, which involve bone regeneration, anti-bacteria/anti-inflammation, and cancer inhibition, etc. This timely review covers the state-of-the-art in these exciting areas and provides the important guidance for next generation PEEK based biomedical device research and development.
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Basgul C, Spece H, Sharma N, Thieringer FM, Kurtz SM. Structure, properties, and bioactivity of 3D printed PAEKs for implant applications: A systematic review. J Biomed Mater Res B Appl Biomater 2021; 109:1924-1941. [PMID: 33856114 DOI: 10.1002/jbm.b.34845] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 12/14/2022]
Abstract
Additive manufacturing (AM) of high temperature polymers, specifically polyaryletherketones (PAEK), is gaining significant attention for medical implant applications. As 3D printing systems evolve toward point of care manufacturing, research on this topic continues to expand. Specific regulatory guidance is being developed for the safe management of 3D printing systems in a hospital environment. PAEK implants can benefit from many advantages of AM such as design freedom, material and antibacterial drug incorporation, and enhanced bioactivity provided by cancellous bone-like porous designs. In addition to AM PAEK bioactivity, the biomechanical strength of 3D printed implants is crucial to their performance and thus widely studied. In this review, we discuss the printing conditions that have been investigated so far for additively manufactured PAEK implant applications. The effect of processing parameters on the biomechanical strength of implants is summarized, and the bioactivity of PAEKs, along with material and drug incorporation, is also covered in detail. Finally, the therapeutic areas in which 3D printed PAEK implants are investigated and utilized are reviewed.
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Affiliation(s)
- Cemile Basgul
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Hannah Spece
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Neha Sharma
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Florian M Thieringer
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA.,Exponent, Inc, Philadelphia, Pennsylvania, USA
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20
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Verma S, Sharma N, Kango S, Sharma S. Developments of PEEK (Polyetheretherketone) as a biomedical material: A focused review. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2021.110295] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Schwarz EM, McLaren AC, Sculco TP, Brause B, Bostrom M, Kates SL, Parvizi J, Alt V, Arnold WV, Carli A, Chen AF, Choe H, Coraça‐Huber DC, Cross M, Ghert M, Hickok N, Jennings JA, Joshi M, Metsemakers W, Ninomiya M, Nishitani K, Oh I, Padgett D, Ricciardi B, Saeed K, Sendi P, Springer B, Stoodley P, Wenke JC. Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work. J Orthop Res 2021; 39:227-239. [PMID: 31997412 PMCID: PMC7390691 DOI: 10.1002/jor.24616] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
Antibiotic-loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high-dose local delivery is essential to eradicate biofilm-associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon-directed, hand-mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost-effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration-approved high-dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro-organisms. Here, we describe these concerns in detail, and propose areas in need of research.
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Affiliation(s)
- Edward M. Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Alex C. McLaren
- Department of Orthopaedic Surgery, College of Medicine‐Phoenix University of Arizona Phoenix Arizona
| | - Thomas P. Sculco
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Barry Brause
- Department of Infectious Diseases, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Mathias Bostrom
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Stephen L. Kates
- Department of Orthopaedic Surgery Virginia Commonwealth University Richmond Virginia
| | - Javad Parvizi
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Volker Alt
- Department of Trauma Surgery University Medical Centre Regensburg Regensburg Germany
| | - William V. Arnold
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Alberto Carli
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Antonia F. Chen
- Department of Orthopaedics, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Hyonmin Choe
- Department of Orthopaedic Yokohama City University Yokohama Japan
| | - Débora C. Coraça‐Huber
- Department of Orthopaedic Surgery, Experimental Orthopedics, Research Laboratory for Biofilms and Implant Associated Infections Medical University of Innsbruck Innsbruck Austria
| | - Michael Cross
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery McMaster University Hamilton Ontario Canada
| | - Noreen Hickok
- Department of Orthopaedic Surgery, Department of Biochemistry & Molecular Biology Thomas Jefferson University Philadelphia Pennsylvania
| | | | - Manjari Joshi
- Division of Infectious Diseases, R Adams Cowley Shock Trauma Center University of Maryland Baltimore Maryland
| | | | - Mark Ninomiya
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kohei Nishitani
- Department of Orthopaedic Surgery Graduate School of Medicine, Kyoto University Sakyo Kyoto Japan
| | - Irvin Oh
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Douglas Padgett
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Benjamin Ricciardi
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kordo Saeed
- Southampton University Hospitals NHS Foundation Trust, Department of Microbiology, Microbiology and Innovation Research Unit (MIRU) and University of Southampton, School of Medicine Southampton UK
| | - Parham Sendi
- Institute for Infectious Diseases University of Bern, Bern and Department of Infectious Diseases, Hospital Epidemiology and Department of Orthopaedics and Traumatology, University of Basel Basel Switzerland
- Department of Orthopaedics and Traumatology University Hospital Basel Basel Switzerland
| | - Bryan Springer
- Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center Atrium Musculoskeletal Institute Charlotte North Carolina
| | - Paul Stoodley
- Department of Microbial Infection and Immunity and Orthopaedics The Ohio State University Columbus Ohio
| | - Joseph C. Wenke
- Orthopaedic Trauma Department U.S. Army Institute of Surgical Research Fort Sam Houston Texas
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Liu Y, Li Y, Shi L. Controlled drug delivery systems in eradicating bacterial biofilm-associated infections. J Control Release 2021; 329:1102-1116. [DOI: 10.1016/j.jconrel.2020.10.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022]
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Delaney LJ, Basgul C, MacDonald DW, Fitzgerald K, Hickok NJ, Kurtz SM, Forsberg F. Acoustic Parameters for Optimal Ultrasound-Triggered Release from Novel Spinal Hardware Devices. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:350-358. [PMID: 31732196 PMCID: PMC7139856 DOI: 10.1016/j.ultrasmedbio.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 05/06/2023]
Abstract
Post-operative infection is a catastrophic complication of spinal fusion surgery, with rates as high as 10%, and existing preventative measures (i.e., peri-operative antibiotics) are only partially successful. To combat this clinical problem, we have designed a drug delivery system around polyether ether ketone clips to be used for prophylactic post-surgical release of antibiotics upon application of ultrasound. The overall hypothesis is that antimicrobial release from this system will aggressively combat post-surgical bacterial survival. This study investigated a set of acoustic parameters optimized for in vitro ultrasound-triggered coating rupture and subsequent release of encapsulated prophylactic antibiotics. We determined that a transducer frequency of 1.7 MHz produced the most consistent burst release and that, at this frequency, a pulse repetition frequency of 6.4 kHz and acoustic output power of 100% (3.41 MPa) produced the greatest release, representing an important proof of principle and the basis for continued development of this novel drug delivery system.
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Affiliation(s)
- Lauren J Delaney
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Cemile Basgul
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel W MacDonald
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Keith Fitzgerald
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven M Kurtz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA; Exponent, Inc., Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Schachtner J, Frohbergh M, Hickok N, Kurtz S. Are Medical Grade Bioabsorbable Polymers a Viable Material for Fused Filament Fabrication? J Med Device 2019; 13:0310081-310085. [PMID: 31700564 DOI: 10.1115/1.4043841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/17/2019] [Indexed: 11/08/2022] Open
Abstract
Lumbar fusion surgery has grown in popularity as a solution to lower back pain. Surgical site infection (SSI) is a serious complication of spinal surgery, affecting as high as 8.5% of the patient population. If the SSI cannot be eradicated with intravenous antibiotics, the next step is second surgery, which increases the cost imposed on the patient and extends recovery time. An implantable ultrasound-triggered polyether ether ketone device for the dispersal of antibiotics has been developed as a potential solution. In this study, the device was constructed of bioabsorbable medical grade polymer, enabling gradual degradation, and manufactured via fused filament fabrication (FFF). A novel bioabsorbable filament was manufactured and validated with gel permeation chromatography (GPC) and differential scanning calorimetry (DSC). The filament was consistent in molecular weight and thermal properties (p = 0.348 and p = 0.487, respectively). The filament was utilized for FFF of the device. Dimensional accuracy of the device was assessed with μCT analysis. Dimensional differences between the printed device and intended design were minimal. Degradation of raw material, filament, and the device was performed in accordance to ASTM F1635-16 for a month to determine how melting the material impacted the degradation properties. The degradation rate was found to be similar among the samples weeks one through three however, the raw material degraded at a slower rate by the final week (p = 0.039). This study demonstrated the feasibility of utilizing medical grade bioabsorbable polymers in FFF.
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Affiliation(s)
- Jaclyn Schachtner
- Department of Biomedical Engineering,Drexel University, 3440 Market Street, Suite 600, Philadelphia, PA 19104
| | - Michael Frohbergh
- Exponent, Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104 e-mail:
| | - Noreen Hickok
- Department of Orthopedics, Thomas Jefferson University, 1015 Walnut Street Curtis Building, Room 501, Philadelphia, PA 19107 e-mail:
| | - Steven Kurtz
- Exponent, Inc., 3440 Market St. Suite 600, Philadelphia, PA 19104 e-mail:
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